The Nutrition Care The Nutrition Care Process for Binge Process for Binge Eating DisorderEating Disorder

Leah BekkerusLeah Bekkerus

Concordia CollegeConcordia College

Moorhead, MNMoorhead, MN

Objectives:Objectives:

Be able to identify Binge Eating Disorder Be able to identify Binge Eating Disorder (BED)(BED)

Identify the two types of binge eating Identify the two types of binge eating disorderdisorder

Identify the factors that contribute to binge Identify the factors that contribute to binge eating disordereating disorder

Understand the nutrition care process Understand the nutrition care process associated with binge eating disorderassociated with binge eating disorder

Understand motivational interviewingUnderstand motivational interviewing Be able to identify ethical issues associated Be able to identify ethical issues associated

with binge eating disorderwith binge eating disorder

StatisticsStatistics

1 in 142 people in the United States 1 in 142 people in the United States suffer from binge eating disordersuffer from binge eating disorder

Approximately 1.9 million peopleApproximately 1.9 million people 2% of United States population2% of United States population Has become the most Has become the most

common eating disordercommon eating disorder

What is Binge Eating What is Binge Eating Disorder?Disorder?

Binge Defined:Binge Defined: An act of excessive or compulsive An act of excessive or compulsive

consumption consumption Binge Eating Disorder Defined:Binge Eating Disorder Defined:

An eating disorder characterized by recurring An eating disorder characterized by recurring episodes of binge eating accompanied by a episodes of binge eating accompanied by a sense of lack of control and often negative sense of lack of control and often negative feelings about oneself but without intervening feelings about oneself but without intervening periods of compensatory behavior. periods of compensatory behavior.

Merriam- Webster’s Medical DictionaryMerriam- Webster’s Medical Dictionary

What is Binge Eating What is Binge Eating Disorder? (cont.)Disorder? (cont.)

Frequent episodes of uncontrollable binge Frequent episodes of uncontrollable binge eatingeating

Feeling extremely distressed or upset Feeling extremely distressed or upset during or after the bingeduring or after the binge

No regular attempts to “make up” for the No regular attempts to “make up” for the bingebinge

VomitingVomiting FastingFasting OverexercisingOverexercising

Types of Binge EatingTypes of Binge Eating

Objective Binge Eating (OBE)Objective Binge Eating (OBE) Loss of control over eatingLoss of control over eating Large amount of food is consumedLarge amount of food is consumed

Subjective Binge Eating (SBE)Subjective Binge Eating (SBE) Sense of out of control over eatingSense of out of control over eating Large amount of food not consumedLarge amount of food not consumed

Binge Eating Disorder vs.Binge Eating Disorder vs.Objective OvereatingObjective Overeating

Binge Eating DisorderBinge Eating Disorder Sense the loss of controlSense the loss of control Feel remorse Feel remorse Consume excess amounts of foodConsume excess amounts of food

Objective OvereatingObjective Overeating Do not sense the loss of controlDo not sense the loss of control Consume excess amounts of foodConsume excess amounts of food

Who is at Risk for Binge Who is at Risk for Binge Eating Disorder?Eating Disorder?

EveryoneEveryone 2% of men2% of men 3.5% of women3.5% of women

Usually late onset (40’s)Usually late onset (40’s) Can happen in younger yearsCan happen in younger years People who are over weight or obesePeople who are over weight or obese

Over weight: BMI 25-29.9Over weight: BMI 25-29.9 Obese: BMI Obese: BMI >> 30 30

People of a healthy weightPeople of a healthy weight BMI 18.5-24.9BMI 18.5-24.9

Causes of Binge Eating Causes of Binge Eating DisorderDisorder

Negative self imageNegative self image DepressionDepression Negative moodNegative mood SadnessSadness Emotional eatingEmotional eating BoredomBoredom WorryWorry StressStress AngerAnger Failed dietingFailed dieting

Psychological effects of Psychological effects of Binge Eating DisorderBinge Eating Disorder

Can elevate negative self imageCan elevate negative self image Can enhance depressionCan enhance depression Becomes an addictionBecomes an addiction Begin to obsess over self controlBegin to obsess over self control

Risk Factors of Binge Risk Factors of Binge Eating DisorderEating Disorder

Binge eating causesBinge eating causes Weight gainWeight gain Results Results obesity obesity

Obesity causes:Obesity causes: Type 2 diabetesType 2 diabetes High cholesterolHigh cholesterol High blood pressureHigh blood pressure Heart diseaseHeart disease Sleep apneaSleep apnea

Signs of Binge Eating Signs of Binge Eating Disorder:Disorder:

Eating more rapidly than usualEating more rapidly than usual Eating until uncomfortably fullEating until uncomfortably full Eating large amounts of food when not Eating large amounts of food when not

hungryhungry Eating alone to hide actual food intakeEating alone to hide actual food intake Feelings of disgust, depression, or guilt Feelings of disgust, depression, or guilt

after eatingafter eating

The Cycle of Binge Eating The Cycle of Binge Eating DisorderDisorder

The Nutrition Care The Nutrition Care ProcessProcess

AssessmentAssessment Collect and interpret laboratory values Collect and interpret laboratory values

DiagnosisDiagnosis Determine illness or disorderDetermine illness or disorder Find contributing factorsFind contributing factors

InterventionIntervention Care planCare plan

MonitorMonitor Evaluate the Nutrition Care ProcessEvaluate the Nutrition Care Process

Nutrition Care Process: Nutrition Care Process: AssessmentAssessment Assess the patients caloric intakeAssess the patients caloric intake

Determine if it is within their acceptable Determine if it is within their acceptable rangerange

Record patient’s:Record patient’s: Height (cm)Height (cm) Weight (kg)Weight (kg) Ideal Body weightIdeal Body weight

Males: 106 lbs./5 ft. + 6 lbs./ in.Males: 106 lbs./5 ft. + 6 lbs./ in. Females: 100 lbs./5 ft. + 5 lbs./in.Females: 100 lbs./5 ft. + 5 lbs./in.

Ideal Caloric intake (Mifflin- St. Jeor)Ideal Caloric intake (Mifflin- St. Jeor) Males: (9.9 x wt) +(6.25 x ht) – (4.92 x age) + (5 x SF)Males: (9.9 x wt) +(6.25 x ht) – (4.92 x age) + (5 x SF) Females: (9.9 x wt) + (6.25 x ht) – (4.92 X age) – (161 x Females: (9.9 x wt) + (6.25 x ht) – (4.92 X age) – (161 x

SF)SF) SF: Stress Factor 1.3-1.5SF: Stress Factor 1.3-1.5

Nutrition Care Process: Nutrition Care Process: AssessmentAssessment

Determine why the over eating occursDetermine why the over eating occurs Stress levelsStress levels Emotional eatingEmotional eating DepressionDepression

Determine if the patient is overweight or obeseDetermine if the patient is overweight or obese BMI: Body Mass IndexBMI: Body Mass Index

Weight (kg)Weight (kg) Height (m squared)Height (m squared)

Overweight: BMI 25-29.9Overweight: BMI 25-29.9 Obese: BMI Obese: BMI >> 30 30

Nutrition Care Process: Nutrition Care Process: AssessmentAssessment

Nutrition Care Process: Nutrition Care Process: DiagnosisDiagnosis

Binge eating disorderBinge eating disorder Overweight or obeseOverweight or obese Determine contributing factors to Determine contributing factors to

the binge eating disorderthe binge eating disorder

Nutrition Care Process:Nutrition Care Process:InterventionIntervention

Four common practices of treatmentFour common practices of treatment PsychotherapyPsychotherapy

Cognitive behavioral therapyCognitive behavioral therapy Interpersonal therapyInterpersonal therapy Dialectal behavior therapyDialectal behavior therapy

MedicationMedication AntidepressantsAntidepressants Anticonvulsants (Topamax)Anticonvulsants (Topamax) Anti-obesity medication (Meridia)Anti-obesity medication (Meridia)

Behavioral weight-loss programsBehavioral weight-loss programs Self help strategiesSelf help strategies

Nutrition Care Process:Nutrition Care Process:Intervention Intervention (cont.)(cont.)

The Goal of the RDThe Goal of the RDHelp the patientHelp the patient Learn self monitoring skillsLearn self monitoring skills Develop regular eating patternsDevelop regular eating patterns Learn alternatives to binge eatingLearn alternatives to binge eating Develop problem solving skillsDevelop problem solving skills Reduce restrained eatingReduce restrained eating Evaluate thoughts on eating and self controlEvaluate thoughts on eating and self control

Motivational InterviewingMotivational Interviewing

A method of communication with A method of communication with your patient.your patient.

Started as a tool for addiction Started as a tool for addiction counselingcounseling

What can the RD do?What can the RD do? Give them insightGive them insight Give them knowledgeGive them knowledge Give them skillsGive them skills Give them a hard timeGive them a hard time

Motivational Interviewing Motivational Interviewing cont.cont.

The focus is where the patient is.The focus is where the patient is. Example: Tell me what you know…Example: Tell me what you know…

The Spirit of Motivational The Spirit of Motivational Interviewing:Interviewing: Collaboration- not confrontationCollaboration- not confrontation Autonomy- not authorityAutonomy- not authority Evocation- Not education/ adviceEvocation- Not education/ advice

Example: What are you willing to try to doExample: What are you willing to try to do??

Motivational Interviewing Motivational Interviewing cont.cont.

Principles of Motivational Principles of Motivational InterviewingInterviewing Express EmpathyExpress Empathy Self EfficacySelf Efficacy Develop DiscrepancyDevelop Discrepancy Role with ResistanceRole with Resistance

Motivational Interviewing Motivational Interviewing cont.cont.

Using Motivational InterviewingUsing Motivational Interviewing Must use different communication Must use different communication

methodsmethods

Open End QuestionsOpen End Questions AffirmAffirm Reflective Listening (key skill!)Reflective Listening (key skill!) SummarizeSummarize

Motivational Interviewing Motivational Interviewing cont.cont.

Reach for change: Reach for change: Have the clientHave the client Think about itThink about it Read about itRead about it Agree to talk about it at another Agree to talk about it at another

sessionsession Take on a small stepTake on a small step Follow upFollow up

Nutrition Care Process: Nutrition Care Process: MonitoringMonitoring

Monitor the patient’s progressMonitor the patient’s progress Encourage them to keep a journalEncourage them to keep a journal Schedule future meetingsSchedule future meetings Assess the progression of their recoveryAssess the progression of their recovery Evaluate the Nutrition care processEvaluate the Nutrition care process

Ethical issues:Ethical issues:

Obesity and Binge Eating DisorderObesity and Binge Eating Disorder Which is treated first?Which is treated first?

Using Topomax (anticonvulsant medication)Using Topomax (anticonvulsant medication) Binge eaters are not convulsingBinge eaters are not convulsing Do we risk the possible side effects?Do we risk the possible side effects? Are we doing more harm than good?Are we doing more harm than good?

Binge eating disorder is mainly a psychological Binge eating disorder is mainly a psychological disorderdisorder Do we use autonomy or a surrogate decision Do we use autonomy or a surrogate decision

maker?maker?

Binge eating self check:Binge eating self check:

Do you:Do you: Feel out of control when you are eating?Feel out of control when you are eating? Think about food all the time?Think about food all the time? Eat in secret?Eat in secret? Eat until you feel sick?Eat until you feel sick? Eat to escape from worries or to comfort Eat to escape from worries or to comfort

yourself?yourself? Feel disgusted or ashamed after eating?Feel disgusted or ashamed after eating? Feel powerless to stop eating, even if you Feel powerless to stop eating, even if you

want to?want to?

SummarySummary

Binge eating disorder sends people into Binge eating disorder sends people into episodes where they can not control the episodes where they can not control the amount of food they are consuming.amount of food they are consuming.

Binge eating can affect anyoneBinge eating can affect anyone There are many psychological factors to There are many psychological factors to

binge eating disorderbinge eating disorder Binge eating can result in obesity and Binge eating can result in obesity and

other serious future complications.other serious future complications.

Summary (cont.)Summary (cont.)

There are definite signs of BEDThere are definite signs of BED It is important as a RD to use the Nutrition It is important as a RD to use the Nutrition

Care Process when assessing BED.Care Process when assessing BED. Motivational Interviewing is an intervention Motivational Interviewing is an intervention

technique that helps you work with your technique that helps you work with your patients to make progress.patients to make progress.

It is important to remain in contact with It is important to remain in contact with your patients to check their progress.your patients to check their progress.

Summary (Cont.)Summary (Cont.)

Questions?Questions?

References:References:

Arbaizar, B., Gomez-Acebo, I., & Llorca, J. (2008). Efficacy of topiramate in Arbaizar, B., Gomez-Acebo, I., & Llorca, J. (2008). Efficacy of topiramate in bulimiabulimia

nervosa and binge-eating disorder: A systematic review.nervosa and binge-eating disorder: A systematic review. General Hospital General Hospital Psychiatry, 30Psychiatry, 30(5), 471-475. (5), 471-475.

Binge eating disorder.Binge eating disorder. Retrieved 10/2/2008, 2008, from Retrieved 10/2/2008, 2008, from http://www.athealth.com/Consumer/disorders/Bingeeating.html

Binge eating status influences pre-diet weight change and test meal intake Binge eating status influences pre-diet weight change and test meal intake inin

obese individuals.(2008). obese individuals.(2008). Appetite, 51Appetite, 51(2), 408. (2), 408. Binge-eating disorder - MayoClinic.com.Binge-eating disorder - MayoClinic.com. Retrieved 10/2/2008, 2008, from Retrieved 10/2/2008, 2008, from

http://www.mayoclinic.com/health/binge-eating-disorder/DS00608 Binge-eating disorder: What's the best treatment?Binge-eating disorder: What's the best treatment? Retrieved 10/2/2008, Retrieved 10/2/2008,

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Bisaga, A., Danysz, W., & Foltin, R. W. (2008). Antagonism of glutamatergic Bisaga, A., Danysz, W., & Foltin, R. W. (2008). Antagonism of glutamatergic NMDA and mGluR5 receptors decreases consumption of food in baboon model of NMDA and mGluR5 receptors decreases consumption of food in baboon model of binge-eating disorder.binge-eating disorder. European Neuropsychopharmacology : The Journal of the European Neuropsychopharmacology : The Journal of the European College of Neuropsychopharmacology, European College of Neuropsychopharmacology,

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References References (Cont.):(Cont.):

Dingemans, A. E., Martijn, C., Jansen, A. T., & van Furth, E. F. (2008). Dingemans, A. E., Martijn, C., Jansen, A. T., & van Furth, E. F. (2008). The effect of suppressing negative emotions on eating behavior in binge eating disorder.The effect of suppressing negative emotions on eating behavior in binge eating disorder. Appetite, Appetite,

Laura Alderman, M. E. (2007). Laura Alderman, M. E. (2007). Motivational interviewing. Motivational interviewing. Unpublished manuscript. Unpublished manuscript. Melinda Smith, M. A., Suzanne Barston, Robert Segal, M.A. & Jeanne Segal, P. D. (2008). Melinda Smith, M. A., Suzanne Barston, Robert Segal, M.A. & Jeanne Segal, P. D. (2008).

Binge eating disorder.Binge eating disorder. Retrieved September 25, 2008, from Retrieved September 25, 2008, from http://helpguide.org/mental/binge_eating_disorder.html

The onset and course of binge eating in 8- to 13-year-old healthy weight, overweight The onset and course of binge eating in 8- to 13-year-old healthy weight, overweight obese children.(2008). obese children.(2008). Eating Behaviors, Eating Behaviors,

Position of the american dietetic association nutrition intervention in the treatment of Position of the american dietetic association nutrition intervention in the treatment of anorexia anorexia

nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS).(2001). nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS).(2001). Journal of the Journal of the American Dietetic Association, 101American Dietetic Association, 101(7), 810. (7), 810.

Raynor, H., & Zemel, P. (1996). Binge eating disorder and the dietitian's role.Raynor, H., & Zemel, P. (1996). Binge eating disorder and the dietitian's role. Journal of the American Dietetic Association, 96Journal of the American Dietetic Association, 96(9), 854. (9), 854.

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Photo ReferencesPhoto References

http://www.medmaps.co.uk/Mindmaps/Psychiatry/Binge%20eatinghttp://www.medmaps.co.uk/Mindmaps/Psychiatry/Binge%20eating%20disorder.htm%20disorder.htm

http://www.mhguidelines-leics.nhs.uk/default.aspx?http://www.mhguidelines-leics.nhs.uk/default.aspx?page=eating_carepage=eating_care

http://www.brookes.ac.uk/student/services/health/Images/binge.gifhttp://www.brookes.ac.uk/student/services/health/Images/binge.gif http://www.aweighout.com/binge-eating/binge-eating.shtmlhttp://www.aweighout.com/binge-eating/binge-eating.shtml http://dorischua.com/wp-content/uploads/2007/11/eating.jpghttp://dorischua.com/wp-content/uploads/2007/11/eating.jpg http://sfhelp.org/art/Overeat.gifhttp://sfhelp.org/art/Overeat.gif http://keetsa.com/blog/wp-content/uploads/2007/10/ask-these-http://keetsa.com/blog/wp-content/uploads/2007/10/ask-these-

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